Chronic stable angina guidelines for pharmacotherapy to improve prognosis and reduce symptoms: Difference between revisions
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==ACC/AHA Guidelines- Pharmacotherapy to Prevent MI and Death and Reduce Symptoms (DO NOT EDIT)<ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. [http://circ.ahajournals.org/content/99/21/2829.full.pdf] PMID: [http://pubmed.gov/10351980 10351980]</ref><ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).] ''Circulation'' 107 (1):149-58.[http://content.onlinejacc.org/cgi/reprint/41/1/159.pdf] PMID: [http://pubmed.gov/12515758 12515758]</ref><ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina.] ''Circulation'' 116 (23):2762-72.[http://content.onlinejacc.org/cgi/reprint/50/23/2264.pdf] PMID: [http://pubmed.gov/17998462 17998462]</ref>== | '''Editors-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; {{CZ}}; '''Associate Editor(s)-In-Chief:''' [[John Fani Srour, M.D.]]; [[WikiDoc Scholars#WikiDoc Scholars with Distinction|Jinhui Wu, M.D.]]; [[Lakshmi Gopalakrishnan|Lakshmi Gopalakrishnan, M.B.B.S.]] | ||
==ACC/AHA Guidelines- Pharmacotherapy to Prevent MI and Death and Reduce Symptoms (DO NOT EDIT) <ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. [http://circ.ahajournals.org/content/99/21/2829.full.pdf] PMID: [http://pubmed.gov/10351980 10351980]</ref> <ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).] ''Circulation'' 107 (1):149-58.[http://content.onlinejacc.org/cgi/reprint/41/1/159.pdf] PMID: [http://pubmed.gov/12515758 12515758]</ref> <ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina.] ''Circulation'' 116 (23):2762-72.[http://content.onlinejacc.org/cgi/reprint/50/23/2264.pdf] PMID: [http://pubmed.gov/17998462 17998462]</ref>== | |||
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===Class I=== | ===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]=== | ||
'''1.''' [[Aspirin]] should be started at 75 to 162 mg per day and continued indefinitely in all patients unless contraindicated. ''(Level of Evidence: A)'' | '''1.''' [[Chronic stable angina treatment aspirin|Aspirin]] should be started at 75 to 162 mg per day and continued indefinitely in all patients unless contraindicated. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' | ||
'''2.''' Use of [[warfarin]] in conjunction with [[Chronic stable angina treatment aspirin|aspirin]] and/or [[Chronic stable angina treatment clopidogrel|clopidogrel]] is associated with an increased risk of bleeding and should be monitored closely. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' | |||
'''3.''' [[Chronic stable angina treatment calcium channel blockers|Calcium antagonists]] (short-acting dihydropyridine calcium antagonists should be avoided) and/or long-acting [[Chronic stable angina treatment nitrates|nitrates]] as initial therapy for reduction of symptoms when [[Chronic stable angina treatment beta blockers|beta-blockers]] are contraindicated. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' | |||
''' | '''4.''' [[Chronic stable angina treatment calcium channel blockers|Calcium antagonists]] (short-acting dihydropyridine calcium antagonists should be avoided) and/or long-acting [[Chronic stable angina treatment nitrates|nitrates]] in combination with [[Chronic stable angina treatment beta blockers|beta-blockers]] when initial treatment with beta-blockers is not successful. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' | ||
''' | '''5.''' [[Chronic stable angina treatment calcium channel blockers|Calcium antagonists]] (short-acting dihydropyridine calcium antagonists should be avoided) and/or long-acting [[Chronic stable angina treatment nitrates|nitrates]] as a substitute for [[Chronic stable angina treatment beta blockers|beta-blockers]] if initial treatment with beta-blockers leads to unacceptable side effects. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' | ||
''' | '''6.''' [[Chronic stable angina treatment nitrates|Sublingual nitroglycerin or nitroglycerin spray]] for the immediate relief of angina. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' | ||
''' | '''7.''' It is beneficial to start and continue [[Chronic stable angina treatment beta blockers|beta-blocker]] therapy indefinitely in all patients who have had [[MI]], [[acute coronary syndrome]], or [[left ventricular dysfunction]] with or without [[heart failure]] symptoms, unless contraindicated. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' | ||
''' | '''8.''' [[ACE inhibitors]] in all patients with significant [[coronary artery disease]] by [[Chronic stable angina coronary angiography|angiography]] or [[MI|previous myocardial infarction]] who also have [[diabetes]] and/or [[left ventricular dysfunction|left ventricular systolic dysfunction]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' | ||
''' | '''9.''' [[ACE inhibitors]] should be started and continued indefinitely in all patients with [[EF|left ventricular ejection fraction]] less than or equal to 40% and in those with [[hypertension]], [[diabetes]], or [[chronic kidney disease]] unless contraindicated. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' | ||
''' | '''10.''' [[ACE inhibitors]] should be started and continued indefinitely in patients who are not lower risk (lower risk defined as those with normal [[EF|left ventricular ejection fraction]] in whom cardiovascular risk factors are well controlled and [[Chronic stable angina revascularization percutaneous coronary intervention(PCI)|revascularization]] has been performed), unless contraindicated. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' | ||
''' | '''11.''' [[Angiotensin receptor blockers]] are recommended for patients who have [[hypertension]], have indications for but are intolerant of [[ACE inhibitors]], have [[heart failure]], or have had a [[myocardial infarction]] with [[EF|left ventricular ejection fraction]] less than or equal to 40%. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' | ||
''' | '''12.''' [[Aldosterone antagonist|Aldosterone blockade]] is recommended for use in [[MI|post-MI]] patients without significant [[Renal insufficiency|renal dysfunction]] (creatinine should be less than 2.5 mg per dL in men and less than 2.0 mg per dL in women) or [[hyperkalemia]] (potassium should be less than 5.0 mEq per L) who are already receiving therapeutic doses of an [[ACE inhibitor]] and a [[Chronic stable angina treatment beta blockers|beta blocker]], have a [[EF|left ventricular ejection fraction]] less than or equal to 40%, and have either [[diabetes]] or [[heart failure]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' | ||
''' | '''1.''' [[Chronic stable angina treatment anti-lipid agents|Lipid-lowering therapy]] in patients with documented or suspected [[CAD]] and [[LDL|LDL-cholesterol]] more than 130 mg/dL with a target [[LDL]] of less than 100 mg/dL. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' | ||
''' | ===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]=== | ||
'''1.''' [[Chronic stable angina treatment clopidogrel|Clopidogrel]] when [[Chronic stable angina treatment aspirin|aspirin]] is absolutely contraindicated. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' | |||
'''2.''' Long-acting non-dihydropyridine [[Chronic stable angina treatment calcium channel blockers|calcium antagonists]] (short-acting dihydropyridine calcium antagonists should be avoided) instead of [[Chronic stable angina treatment beta blockers|beta-blockers]] as initial therapy. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' | |||
''' | |||
''' | '''3.''' [[ACE inhibitor]] in patients with [[coronary artery disease]] by [[Chronic stable angina coronary angiography|angiography]] or [[MI|previous myocardial infarction]] or other vascular disease. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' | ||
''' | '''4.''' It is reasonable to use [[ACE inhibitors]] among lower-risk patients with mildly reduced or normal [[EF|left ventricular ejection fraction]] in whom cardiovascular risk factors are well controlled and [[Chronic stable angina revascularization percutaneous coronary intervention(PCI)|revascularization]] has been performed. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' | ||
''' | '''1.''' [[Chronic stable angina treatment anti-lipid agents|Lipid-lowering therapy]] in patients with documented or suspected [[CAD]] and [[LDL|LDL-cholesterol]] 100 to 129 mg/dL, with a target [[LDL]] of 100 mg/dL. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' | ||
===Class IIb=== | ===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]=== | ||
'''1.''' [[Angiotensin receptor blockers]] may be considered in combination with [[ACE inhibitors]] for [[heart failure]] due to | '''1.''' [[Chronic stable angina treatment angiotensin converting enzyme inhibitors (ACEI) and renin angiotensin aldosterone system blockers (RAAS blockers)|Angiotensin receptor blockers]] may be considered in combination with [[Chronic stable angina treatment angiotensin converting enzyme inhibitors (ACEI) and renin angiotensin aldosterone system blockers (RAAS blockers)|ACE inhibitors]] for [[heart failure]] due to [[left ventricular systolic dysfunction]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' | ||
[[left ventricular systolic dysfunction]]. ''(Level of Evidence: B)'' | |||
===Class III=== | ===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]=== | ||
'''1.''' [[Dipyridamole]]. ''(Level of Evidence: B)'' | '''1.''' [[Chronic stable angina treatment dipyridamole|Dipyridamole]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' | ||
'''2.''' [[Chelation therapy]] (intravenous infusions of ethylenediamine tetraacetic acid or [[EDTA]]) is not recommended for the | '''2.''' [[Chelation therapy]] (intravenous infusions of ethylenediamine tetraacetic acid or [[EDTA]]) is not recommended for the treatment of [[Chronic stable angina definition|chronic angina]] or [[CAD|arteriosclerotic cardiovascular disease]] and may be harmful because of its potential to cause [[hypocalcemia]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}} | ||
treatment of | |||
==Vote on and Suggest Revisions to the Current Guidelines== | ==Vote on and Suggest Revisions to the Current Guidelines== |
Revision as of 14:26, 26 August 2011
Chronic stable angina Microchapters | ||
Classification | ||
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Differentiating Chronic Stable Angina from Acute Coronary Syndromes | ||
Diagnosis | ||
Alternative Therapies for Refractory Angina | ||
Discharge Care | ||
Guidelines for Asymptomatic Patients | ||
Case Studies | ||
Chronic stable angina guidelines for pharmacotherapy to improve prognosis and reduce symptoms On the Web | ||
FDA on Chronic stable angina guidelines for pharmacotherapy to improve prognosis and reduce symptoms | ||
CDC onChronic stable angina guidelines for pharmacotherapy to improve prognosis and reduce symptoms | ||
Editors-In-Chief: C. Michael Gibson, M.S., M.D. [4] Phone:617-632-7753; Cafer Zorkun, M.D., Ph.D. [5]; Associate Editor(s)-In-Chief: John Fani Srour, M.D.; Jinhui Wu, M.D.; Lakshmi Gopalakrishnan, M.B.B.S.
ACC/AHA Guidelines- Pharmacotherapy to Prevent MI and Death and Reduce Symptoms (DO NOT EDIT) [1] [2] [3]
“ |
Class I1. Aspirin should be started at 75 to 162 mg per day and continued indefinitely in all patients unless contraindicated. (Level of Evidence: A) 2. Use of warfarin in conjunction with aspirin and/or clopidogrel is associated with an increased risk of bleeding and should be monitored closely. (Level of Evidence: B) 3. Calcium antagonists (short-acting dihydropyridine calcium antagonists should be avoided) and/or long-acting nitrates as initial therapy for reduction of symptoms when beta-blockers are contraindicated. (Level of Evidence: B) 4. Calcium antagonists (short-acting dihydropyridine calcium antagonists should be avoided) and/or long-acting nitrates in combination with beta-blockers when initial treatment with beta-blockers is not successful. (Level of Evidence: B) 5. Calcium antagonists (short-acting dihydropyridine calcium antagonists should be avoided) and/or long-acting nitrates as a substitute for beta-blockers if initial treatment with beta-blockers leads to unacceptable side effects. (Level of Evidence: C) 6. Sublingual nitroglycerin or nitroglycerin spray for the immediate relief of angina. (Level of Evidence: C) 7. It is beneficial to start and continue beta-blocker therapy indefinitely in all patients who have had MI, acute coronary syndrome, or left ventricular dysfunction with or without heart failure symptoms, unless contraindicated. (Level of Evidence: A) 8. ACE inhibitors in all patients with significant coronary artery disease by angiography or previous myocardial infarction who also have diabetes and/or left ventricular systolic dysfunction. (Level of Evidence: A) 9. ACE inhibitors should be started and continued indefinitely in all patients with left ventricular ejection fraction less than or equal to 40% and in those with hypertension, diabetes, or chronic kidney disease unless contraindicated. (Level of Evidence: A) 10. ACE inhibitors should be started and continued indefinitely in patients who are not lower risk (lower risk defined as those with normal left ventricular ejection fraction in whom cardiovascular risk factors are well controlled and revascularization has been performed), unless contraindicated. (Level of Evidence: B) 11. Angiotensin receptor blockers are recommended for patients who have hypertension, have indications for but are intolerant of ACE inhibitors, have heart failure, or have had a myocardial infarction with left ventricular ejection fraction less than or equal to 40%. (Level of Evidence: A) 12. Aldosterone blockade is recommended for use in post-MI patients without significant renal dysfunction (creatinine should be less than 2.5 mg per dL in men and less than 2.0 mg per dL in women) or hyperkalemia (potassium should be less than 5.0 mEq per L) who are already receiving therapeutic doses of an ACE inhibitor and a beta blocker, have a left ventricular ejection fraction less than or equal to 40%, and have either diabetes or heart failure. (Level of Evidence: A) 1. Lipid-lowering therapy in patients with documented or suspected CAD and LDL-cholesterol more than 130 mg/dL with a target LDL of less than 100 mg/dL. (Level of Evidence: A) Class IIa1. Clopidogrel when aspirin is absolutely contraindicated. (Level of Evidence: B) 2. Long-acting non-dihydropyridine calcium antagonists (short-acting dihydropyridine calcium antagonists should be avoided) instead of beta-blockers as initial therapy. (Level of Evidence: B) 3. ACE inhibitor in patients with coronary artery disease by angiography or previous myocardial infarction or other vascular disease. (Level of Evidence: B) 4. It is reasonable to use ACE inhibitors among lower-risk patients with mildly reduced or normal left ventricular ejection fraction in whom cardiovascular risk factors are well controlled and revascularization has been performed. (Level of Evidence: B) 1. Lipid-lowering therapy in patients with documented or suspected CAD and LDL-cholesterol 100 to 129 mg/dL, with a target LDL of 100 mg/dL. (Level of Evidence: B) Class IIb1. Angiotensin receptor blockers may be considered in combination with ACE inhibitors for heart failure due to left ventricular systolic dysfunction. (Level of Evidence: B) Class III1. Dipyridamole. (Level of Evidence: B) 2. Chelation therapy (intravenous infusions of ethylenediamine tetraacetic acid or EDTA) is not recommended for the treatment of chronic angina or arteriosclerotic cardiovascular disease and may be harmful because of its potential to cause hypocalcemia. (Level of Evidence: C) |
” |
Vote on and Suggest Revisions to the Current Guidelines
Sources
- Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology [4]
- The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina [1]
- TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina [2]
- The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina [3]
References
- ↑ 1.0 1.1 Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). Circulation 99 (21):2829-48. [1] PMID: 10351980
- ↑ 2.0 2.1 Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation 107 (1):149-58.[2] PMID: 12515758
- ↑ 3.0 3.1 Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation 116 (23):2762-72.[3] PMID: 17998462
- ↑ Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F; et al. (2006). %5bhttp://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/guidelines-angina-FT.pdf%5d "Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology" Check
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value (help). Eur Heart J. 27 (11): 1341–81. doi:10.1093/eurheartj/ehl001. PMID 16735367.